August 2012

Summer Bulletin Online Now

The Summer edition of our Bulletin addresses high frequency percussive ventilation, beginning with an overview of the modality and then following up with two interesting case studies showing how it was used to help pediatric patients at one facility. READ ISSUE

Neonatal-Pediatric Journal Club

August marks the start of our Neonatal-Pediatric Journal Club, an online discussion taking place on AARConnect. Rob DiBlasi and Brian Walsh are leading the discussions, which will target a new topic every couple of months. So sign on to AARConnect and then sign up for the journal club to join the discussion.

AARC Congress 2012 Program Posted

The AARC will head to New Orleans this Nov. 10–13 for AARC Congress 2012. Read through the offerings for our section and see all this year has to offer. You can peruse the program, plus make your hotel arrangements now. VISIT PROGRAM

Microsite Provides a Window on AARC Congress 2012 Venue

You can take a tour of the city right now through our new microsite, set up especially for the Association by the New Orleans Convention & Visitors Bureau. VISIT SITE

Delivery Site Matters for High Risk Births, but Regional Differences Remain

Researchers from the Children’s Hospital of Philadelphia and the University of Pennsylvania School of Medicine find a survival benefit for infants born between 23 and 37 weeks gestation at hospitals with a high level NICU. Their study analyzed outcomes for all hospital-based deliveries between 1995 and 2005 in Pennsylvania and California, and between 1995 and 2003 in Missouri. In Pennsylvania, the results showed 7.8 fewer deaths per 1000 deliveries for infants born at hospitals with high level NICUs. In California 2.7 fewer deaths were seen, and in Missouri, 12.6 fewer deaths were noted. Complication rates were similar for infants born in the high level NICU hospitals across the three states, with three exceptions. Missouri had better bronchopulmonary dysplasia outcomes, with 9.5 fewer cases per 1000 deliveries, and Pennsylvania and California both had higher rates of infections. The authors conclude, “There is benefit to neonatal outcomes when high risk infants are delivered at high level NICUs that is larger than previously reported, although the effects differ between states, which may be attributable to different methods of regionalization.” The study was published ahead of print in Pediatrics on July 9. READ ABSTRACT

Factors Associated with High Flow Nasal Cannula Failure in the PICU

Researchers from Ohio and Tennessee who studied pediatric patients with bronchiolitis who were treated with high flow nasal cannulas in the PICU have identified several factors related to failure of the therapy. The investigation involved a retrospective chart review of 113 children. Responders to the therapy were compared with nonresponders. Response to the therapy was not affected by age, sex, or a history of prematurity, but nonresponders were more likely to have been more hypercarbic and less tachypnic prior to the initiation of therapy, and their respiratory rate did not change after therapy was started. They also had higher Pediatric Risk of Mortality III scores in the first 24 hours. The study was published ahead of print in Pediatric Critical Care Medicine on July 14. READ ABSTRACT

Infant Mask Passes CO2 Retention Test

Noting that new aerosols intended to treat respiratory conditions in infants require tight fitting masks, German investigators set out to determine whether these masks may result in carbon dioxide retention. They tested one mask designed for infants and young children using a one dimensional model followed by three dimensional unsteady computational fluid dynamics analyses. After about the fifth respiratory cycle, the modeled CO2 concentration in the mask reached a steady state, defined as 3.2% and 3%, respectively, for normal and distressed breathing patterns. The mean CO2 concentration inspired into the nostril was 2.24% and 2.26%, respectively, for normal and distressed breathing patterns after the steady state was reached. The authors conclude, “The mask is predicted to cause minimal CO2 retention and rebreathing. Infants with normal and distressed breathing should tolerate the mask intermittently delivering aerosols over brief time frames.” The study was published ahead of print in ISRN Pediatrics on June 26. READ ABSTRACT

International Transfusion Practices

A new study out of Christiana Care Health System in Newark, DE, offers some insight into the practice of red cell transfusion in premature infants with <1000-g birth weight and/or <28-week gestation. Researchers there conducted an international web-based survey of neonatologists through their professional societies, asking about the factors that influence their decision to transfuse these infants. Responses were received from 1018, 67.5% from the U.S. Results showed:

• 51.1% reported having a written policy with specific red cell transfusion guidelines in their unit.
• Factors considered “very important” regarding the need to administer blood transfusions included degree of oxygen requirement (44.7%) and need for respiratory support (44.1%).
• Erythropoietin was routinely used to treat anemia by 26.0%.
• Delayed cord clamping or cord milking was practiced by 29.1%.
• A wide variation was seen in the hemoglobin values used to transfuse infants, regardless of postnatal age.
• Step-wise increments in the median hemoglobin cutoffs directly paralleled an increase in the need for levels of respiratory support.
• In the first week of life, there was a wider range in the distribution of hemoglobin transfusion thresholds for infants requiring no respiratory support and full mechanical ventilation compared with the thresholds used in the second, third, and fourth weeks of life.